ATM/Debit Card Application

New Card Details

Applying For	ATM Card VISA Debit Card
Attach Card To	Share Savings Only Share Draft/Checking Only Both
Applicant	Primary Member Joint Owner
If approved the ATM/Debit Card(s) will be mailed to your residence.

Tell us about you

First Name	Last Name	SSN#	Email
Address	City	State	Zip
Phone	Account Number	Date of Birth (mm/dd/yyyy)

Overdraft Coverage Consent

What you need to know about Overdrafts and Overdraft Fees.

An overdraft occurs when you do not have enough money in your account to cover a transaction, but we pay it anyway. We can cover your overdrafts in two different ways:

1. We have standard overdraft practices that come with your account.
2. We also offer overdraft protection plans, such as a link to a savings account, which may be less expensive than our standard overdraft practices. To learn more, ask us about these plans.

This notice explains our standard overdraft practices.

What are the standard overdraft practices that come with my account?

We do authorize and pay overdrafts for the following types of transactions:

• Checks and other transactions made using your checking account number
• Automatic Bill Payments

We do not authorize and pay overdrafts for the following types of transactions unless you ask us to (see below):

• ATM transactions
• Everyday Debit Card transactions

We pay overdrafts at our discretion, which means we do not guarantee that we will always authorize and pay any type of transaction.

If we do not authorize and pay an overdraft, your transaction will be declined.

What fees will I be charged if Baylands Family Credit Union pays my overdraft?

Under our standard overdraft practices:

• We will charge you a fee of up to $34 each time we pay an overdraft.
• There is a limit of 5 overdrafts per day we charge you for overdrawing your account.

What if I want Baylands Family Credit Union to authorize and pay overdrafts on my ATM and everyday debit card transactions?

If you also want us to authorize and pay overdrafts on ATM and everyday debit card transactions, call (804) 843-2520 or (888) 843-2520, visit us on the web at www.baylandsfcu.org, or complete the form below and mail it to: PO Box 392, West Point, VA 23181. You may revoke your authorization at any time by mail, online or in person at one of our offices.

Overdraft Protection Selection

Please check only one option below
I want Baylands Family Credit Union to authorize and pay overdrafts on my ATM and one-time Debit Card transactions. I do not want Baylands Family Credit Union to authorize and pay overdrafts on my ATM and one-time Debit Card transactions.

Signature

By signing below, I request the described services and agree to the terms and conditions governing these services, including any fees and charges. To receive a Baylands Family Credit Union ATM Card, I understand that I must be 18 years of age or older and be an active member in good standing. To receive a Visa Debit Card, I understand that I must be 18 years of age or older and have an active Share Draft Checking Account in good standing. If I am not approved for a Visa Debit Card, I understand that the credit union may offer me the use of a Baylands Family Credit Union ATM Card. I authorize Baylands Family Credit Union to obtain credit bureau and/or similar reports in considering my application as permitted by the Fair Credit Reporting Act. I acknowledge that the information provided in this application is correct. I give the credit union authorization to issue the requested card(s). By using the requested card(s), I/we agree to the terms and conditions of the cardholder agreement and disclosure provided.

Applicant's Signature	Date (mm/dd/yyyy)
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